Abstract
The dorsal-metacarpal-artery (DMCA) flap in its standard or extended version is considered as the working horse to cover dorsal soft tissue finger defects with exposed extensor tendon or bone. We hereby present a clinical case of an 80-year-old male patient who is right-handed and sustained a soft tissue defect of the proximal dorsal aspect of his left 5th finger and the postoperative outcome employing a modified transposition flap. The double-pedicled DMCA flap (dpDMCA flap) of the hand poses in adequate clinical scenarios a comparably fast and safe solution to cover dorsal finger defects extending just distal to the PIP joint. To the best of our knowledge, this is the first report of a DMCA-based flap with a double pedicle to cover soft tissue defects at the dorsum of the hand.Level of Evidence: Level V, therapeutic study.
Highlights
The dorsal-metacarpal-artery (DMCA) flap in its standard or extended version is considered as the working horse to cover dorsal soft tissue finger defects with exposed extensor tendon or bone
Since the first description of the DMCA flap in 1990 [1, 2] and its later modification, the flap became a useful adjunct of the armamentarium for coverage of soft tissue finger defects [3]
There still is ongoing discussion over safety and reliability of the 3rd and 4th web space perforators which serve as a vascular base of DMCA flaps
Summary
The dorsal-metacarpal-artery (DMCA) flap in its standard or extended version is considered as the working horse to cover dorsal soft tissue finger defects with exposed extensor tendon or bone. The vascular supply of the DMCA flap is since its first description [1, 2] and its modifications [3] described as deriving from one single perforating branch from the palmar aspect of the hand. We here describe a novel design of a DMCA-derived flap using two pedicles which in our view will broaden the reconstructive spectrum of dorsal finger defects. On the 5th posttraumatic day, the patient presented to our department with partial necrosis and exposed extensor tendons. With an intact 4th web space perforator, the patient was scheduled for operation with a distally based DMCA-4 flap. Only a weak signal at the level of the 4th web space perforator remained, and we included the 3rd web space perforator into our transposition flap
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